Fatigue Tip Sheet

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Carolyn Vachani RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: April 13, 2009

Fatigue is one of the most common side effects reported by people receiving cancer treatments (surgery, chemotherapy, radiation therapy, or other drug therapy). It has been described as a feeling of exhaustion, feeling completely worn out, feeling that their body is "heavy" and difficult to move, or an inability to concentrate. Fatigue can cause physical, emotional, and mental exhaustion. This can be very distressing to the person experiencing it, as it is not caused by overactivity and is not usually relieved by rest, yet many people will suggest rest as a way to decrease the fatigue. People undergoing therapy can have ups and downs, good days and bad days in the energy department. This tip sheet is meant to give suggestions of ways to make the most of the energy they do have and attempt to prevent fatigue from occurring or from worsening.

Unfortunately, doctors do not know exactly what causes fatigue, and think it probably has several different causes, which makes finding effective treatments difficult. There are two ways to treat fatigue that have been shown to be quite effective in clinical trials: exercise and treatment of anemia.

Treatment of Anemia

Anemia, which is defined as a hemoglobin count of less than 12 grams per deciliter (this is a measure of red blood cells) can be a cause of fatigue. Red blood cells contain hemoglobin, which is responsible for carrying oxygen throughout the body. This oxygen is the fuel for muscles, and low levels of it can lead to fatigue.

It is important to remember that not every person with fatigue has anemia, and not every person with anemia has fatigue. Ask your doctor or nurse about your hemoglobin count to see if you are anemic. If a person has anemia, he or she may be able to receive an injection of a hormone called erythropoietin, which stimulates the body to make more red blood cells to increase the hemoglobin level.

Exercise

Sounds crazy, but exercise has been shown to help relieve fatigue and improve quality of life. Now, we aren't talking about running a marathon - a walk around the neighborhood is more like it! Starting this exercise before fatigue sets in can help prevent fatigue from developing. Try to do some type of activity each day. It may help to ask a friend to join you: walk in a local park with nice scenery, listen to music while you walk, or walk to a destination (the store, dry cleaner, etc.). Make it enjoyable. If you already have fatigue, start small, walk just a few blocks and gradually increase the distance over time.

Some other ideas to help manage fatigue

Allow yourself to rest, but do not overdo it as too much rest can make fatigue worse. A nap during the day should not be longer than 45 minutes to an hour, and you do not want this to interfere with nighttime sleep.

Conserve energy for when you need or want it most (take it easy in the morning so you can make it to the grandkid's soccer game in the afternoon). Eliminate tasks that are unnecessary (do you really need to make the bed everyday?).

Ask for help!! People want to help, they just don't know what to do. Ask a friend to clean, prepare a meal, run an errand, pick up the kids, or just sit and talk. Consider the person's own personality and strengths when assigning a task, and accept that they may do it differently than you. Consider who likes to cook, who is good with the kids, or who doesn't mind cleaning?

Know your bad days. If you know the day after therapy is a bad day, don't make plans for that day. If you work every day, schedule treatment on Friday afternoon to allow the weekend to recover.

Friends and family need to know that even if you make plans, there will be some days were you just can't do it and may have to cancel or adjust the plan.

Sleep problems can add to fatigue. Try to keep a normal sleep schedule (go to bed and wake at the same time), avoid caffeine and talk to your doctor about a sleep aid if you are having trouble.

Take time to re-energize with enjoyable activities such as visiting with friends, a meal out with your significant other, listening to music, or doing a hobby you enjoy.

If you work, talking with your employer about fatigue is crucial. Refer them to websites about fatigue. You may be able to adjust your schedule to work around your energy, or adjust your responsibilities while you are receiving treatment. Talk to your human resources representative about the Americans with Disabilities or Family Medical Leave Acts, sick time and healthcare coverage.

Complementary therapies such as massage, relaxation techniques, meditation, and yoga have been shown to help relieve fatigue.

Make sure your caregivers takes time for themselves. They also become fatigued and need to be at their best in order to help you.